{"id":20896,"date":"2023-04-15T10:22:35","date_gmt":"2023-04-15T03:22:35","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20896"},"modified":"2023-04-17T15:12:56","modified_gmt":"2023-04-17T08:12:56","slug":"ton-tai-ong-dong-mach","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/ton-tai-ong-dong-mach\/","title":{"rendered":"Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb t\u1ed3n t\u1ea1i \u1ed1ng \u0111\u1ed9ng m\u1ea1ch"},"content":{"rendered":"

\u1ed0ng \u0111\u1ed9ng m\u1ea1ch n\u1ed1i \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (t\u1eeb v\u1ecb tr\u00ed ph\u00e2n nh\u00e1nh) v\u1edbi em \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (5-10mm c\u00e1ch n\u01a1i xu\u1ea5t ph\u00e1t \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i). Th\u01b0\u1eddng h\u00ecnh n\u00f3n v\u1edbi l\u1ed7 nh\u1ecf h\u01a1n \u1edf \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i, c\u00f3 th\u1ec3 ng\u1eafn, d\u00e0i, th\u1eb3ng hay ngo\u1eb1n ngo\u00e8o. \u1ed0ng n\u00e0y t\u1ed3n t\u1ea1i v\u00e0 c\u00f3 m\u00e1y ch\u1ea3y qua trong th\u1eddi k\u1ef3 b\u00e0o thai v\u00e0 \u0111\u00f3ng l\u1ea1i sau khi tr\u1ebb sinh ra. <\/strong>T\u1ed3n t\u1ea1i \u1ed1ng \u0111\u1ed9ng m\u1ea1ch<\/a> (PDA): 5-10% b\u1ec7nh tim b\u1ea9m sinh. T\u1ec9 l\u1ec7 Nam\/N\u1eef= 1\/3.<\/strong><\/p>\n

1.\u00a0 \u00a0 Gi\u1ea3i ph\u1eabu v\u00e0 sinh b\u1ec7nh h\u1ecdc:<\/h2>\n

Qu\u00e1 tr\u00ecnh \u0111\u00f3ng \u1ed1ng \u0111\u1ed9ng m\u1ea1ch<\/p>\n

\u0110\u1ea7u ti\u00ean, t\u0103ng s\u1ee9c c\u1ea3n c\u1ee7a tu\u1ea7n ho\u00e0n h\u1ec7 th\u1ed1ng t\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 trong khi gi\u1ea3m \u00e1p l\u1ef1c c\u1ee7a gi\u1ea3m s\u1ee9c c\u1ea3n c\u1ee7a ph\u1ed5i l\u00e0m gi\u1ea3m \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. Nh\u01b0 m\u1ed9t h\u1ec7 qu\u1ea3, sau khi sinh, d\u00f2ng m\u00e1u b\u1eaft \u0111\u1ea7u tr\u00e0o ng\u01b0\u1ee3c t\u1eeb \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0o \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i qua \u1ed1ng \u0111\u1ed9ng m\u1ea1ch, thay v\u00ec theo h\u01b0\u1edbng ng\u01b0\u1ee3c l\u1ea1i nh\u01b0 \u1edf giai \u0111o\u1ea1n b\u00e0o thai. Tuy nhi\u00ean, ch\u1ec9 sau khi sinh m\u1ed9t v\u00e0i gi\u1edd, th\u00e0nh c\u01a1 c\u1ee7a \u1ed1ng \u0111\u1ed9ng m\u1ea1ch co l\u1ea1i r\u00f5 r\u1ec7t v\u00e0 ch\u1ec9 trong 1-8 ng\u00e0y, co c\u01a1 th\u01b0\u1eddng \u0111\u1ee7 \u0111\u1ec3 d\u1eebng to\u00e0n b\u1ed9 d\u00f2ng m\u00e1u. \u0110\u00e2y c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u0111\u00f3ng ch\u1ee9c n\u0103ng c\u1ee7a \u1ed1ng \u0111\u1ed9ng m\u1ea1ch. Sau \u0111\u00f3, trong su\u1ed1t 1 \u0111\u1ebfn 4 th\u00e1ng sau \u0111\u00f3, \u0111\u00f3ng \u0111\u1ed9ng m\u1ea1ch th\u01b0\u1eddng tr\u1edf n\u00ean t\u1eafc gi\u1ea3i ph\u1eabu b\u1edfi s\u1ef1 t\u0103ng sinh c\u00e1c m\u00f4 x\u01a1 v\u00e0o l\u00f2ng \u1ed1ng c\u1ee7a n\u00f3.<\/p>\n

\"minh-hoa-ton-tai-ong-dong-mach\"
H\u00ecnh 1: \u1ed1ng \u0111\u1ed9ng m\u1ea1ch<\/figcaption><\/figure>\n

Nguy\u00ean nh\u00e2n \u0111\u00f3ng \u1ed1ng \u0111\u1ed9ng m\u1ea1ch li\u00ean quan \u0111\u1ebfn t\u0103ng s\u1ef1 oxy h\u00f3a c\u1ee7a d\u00f2ng m\u00e1u qua \u1ed1ng, c\u0169ng nh\u01b0 m\u1ea5t c\u00e1c t\u00e1c \u0111\u1ed9ng g\u00e2y gi\u00e3n m\u1ea1ch prostaglandin E2 (PGE2). \u1ede cu\u1ed9c s\u1ed1ng b\u00e0o thai \u00e1p su\u1ea5t ri\u00eang ph\u1ea7n c\u1ee7a \u1ed1ng \u0111\u1ed9ng m\u1ea1ch (PO2) ch\u1ec9 l\u00e0 15-20mmHg, nh\u01b0ng n\u00f3 t\u0103ng l\u00ean kho\u1ea3ng 100mmHg ch\u1ec9 trong v\u00e0i gi\u1edd sau sinh. H\u01a1n n\u1eefa, nhi\u1ec1u th\u1ef1c nghi\u1ec7m \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng \u0111\u1ed9 co c\u01a1 tr\u01a1n c\u1ee7a th\u00e0nh \u1ed1ng \u0111\u1ed9ng m\u1ea1ch li\u00ean quan nhi\u1ec1u v\u1edbi s\u1ef1 s\u1eb5n c\u00f3 c\u1ee7a O2. Kho\u1ea3ng m\u1ed9t tr\u00ean v\u00e0i ngh\u00ecn tr\u1ebb s\u01a1 sinh, \u1ed1ng kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u00f3ng l\u1ea1i, g\u00e2y c\u00f2n \u1ed1ng \u0111\u1ed9ng m\u1ea1ch, h\u1eadu qu\u1ea3 c\u1ee7a ch\u00fang \u0111\u00e3 \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 \u1edf ch\u01b0\u01a1ng 23. Kh\u00f4ng \u0111\u00f3ng \u1ed1ng \u0111\u1ed9ng m\u1ea1ch \u0111\u01b0\u1ee3c coi l\u00e0 do \u1ed1ng d\u00e3n qu\u00e1 m\u1ee9c g\u00e2y ra b\u1edfi c\u00e1c prostaglandin gi\u00e3n m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t l\u00e0 PGE2 l\u00ean th\u00e0nh \u1ed1ng. Th\u1ef1c t\u1ebf, s\u1eed d\u1ee5ng thu\u1ed1c indomethacin, ch\u00fang s\u1ebd ch\u1eb7n t\u1ed5ng h\u1ee3p c\u00e1c prostaglandin th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn \u0111\u00f3ng \u1ed1ng \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

N\u1ebfu \u1ed1ng \u0111\u1ed9ng m\u1ea1ch (\u00d4\u00d0M) kh\u00f4ng \u0111\u00f3ng => c\u00f3 s\u1ef1\u00a0 th\u00f4ng th\u01b0\u01a1ng sinh l\u00fd b\u00e0o thai gi\u1eefa \u00d0MC v\u00e0 \u00d0MP. Lu\u1ed3ng th\u00f4ng tr\u00e1i-ph\u1ea3i qua \u1ed1ng \u0111\u1ed9ng m\u1ea1ch g\u00e2y t\u0103ng g\u00e1nh ph\u1ed5i, nh\u0129 tr\u00e1i, th\u1ea5t tr\u00e1i, g\u00e2y ra c\u00e1c tri\u1ec7u ch\u1ee9ng h\u00f4 h\u1ea5p, t\u0103ng tu\u1ea7n ho\u00e0n ph\u1ed5i, gi\u00e3n \u00d0MP, nh\u0129 tr\u00e1i v\u00e0 th\u1ea5t tr\u00e1i. Khi lu\u1ed3ng th\u00f4ng tr\u00e1i-ph\u1ea3i l\u1edbn s\u1ebd d\u1eabn \u0111\u1ebfn t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u l\u00ean ph\u1ed5i k\u00e9o d\u00e0i v\u00e0 gi\u1ea3m l\u01b0u l\u01b0\u1ee3ng m\u00e1u ra ngo\u1ea1i bi\u00ean. N\u1ebfu l\u01b0u l\u01b0\u1ee3ng m\u00e1u ngo\u1ea1i bi\u00ean kh\u00f4ng \u0111\u1ee7 s\u1ebd d\u1eabn \u0111\u1ebfn c\u00e1c h\u1ec7 qu\u1ea3:<\/p>\n

+ Gi\u1ea3m t\u01b0\u1edbi m\u00e1u c\u00e1c m\u00f4, c\u01a1 quan (quan tr\u1ecdng nh\u1ea5t l\u00e0 vi\u00eam ru\u1ed9t ho\u1ea1i t\u1eed)<\/p>\n

+ Gi\u1ea3m t\u01b0\u1edbi m\u00e1u th\u00ec t\u00e2m tr\u01b0\u01a1ng.<\/p>\n

+ Gia t\u0103ng \u00e1p l\u1ef1c nh\u0129 tr\u00e1i v\u00e0 th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng g\u00e2y \u1ee9 m\u00e1u l\u00ean h\u1ec7 t\u0129nh m\u1ea1ch ph\u1ed5i.<\/p>\n

2. L\u00e2m s\u00e0ng t\u1ed3n t\u1ea1i \u1ed1ng \u0111\u1ed9ng m\u1ea1ch<\/h2>\n

B\u1ec7nh s\u1eed:<\/h3>\n

Kh\u00f4ng tri\u1ec7u ch\u1ee9ng n\u1ebfu PDA nh\u1ecf.<\/p>\n

Shunt l\u1edbn c\u00f3 th\u1ec3 g\u00e2y nhi\u1ec5m tr\u00f9ng ph\u1ed5i,\u00a0 suy tim (kh\u00f3 th\u1edf, th\u1edf nhanh, ph\u00f9, ti\u1ec3u \u00edt), ch\u1eadm t\u0103ng c\u00e2n.<\/p>\n

Kh\u00e1m l\u00e2m s\u00e0ng<\/h3>\n

+ Th\u1edf nhanh v\u00e0 th\u1edf m\u1ec7t (PDA shunt l\u1edbn). T\u00edm kh\u00e1c bi\u1ec7t ( \u0111\u1ea3o shunt).<\/p>\n

+ M\u1ea1ch n\u1ea3y m\u1ea1nh ch\u00ecm nhanh (m\u1ea1ch Corrigan), ch\u00eanh l\u1ec7ch huy\u1ebft \u00e1p t\u00e2m thu t\u00e2m tr\u01b0\u01a1ng.<\/p>\n

+ Tim to, th\u1ea5t tr\u00e1i t\u0103ng \u0111\u1ed9ng, T2 \u0111anh m\u1ea1ch. \u00c2m th\u1ed5i li\u00ean t\u1ee5c nghe r\u00f5 nh\u1ea5t v\u00f9ng d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i hay c\u1ea1nh \u1ee9c tr\u00e1i cao.<\/p>\n

+ Kh\u00e1m ph\u1ed5i c\u00f3 d\u1ea5u hi\u1ec7u th\u1edf nhanh, co l\u00f5m ng\u1ef1c.<\/p>\n

3.\u00a0 C\u1eadn l\u00e2m s\u00e0ng t\u1ed3n t\u1ea1i \u1ed1ng \u0111\u1ed9ng m\u1ea1ch<\/h2>\n

3.1 \u0110i\u1ec7n t\u00e2m \u0111\u1ed3<\/h3>\n

+ ECG b\u00ecnh th\u01b0\u1eddng n\u1ebfu shunt kh\u00f4ng l\u1edbn.<\/p>\n

+ L\u1edbn 2 th\u1ea5t khi shunt l\u1edbn. N\u1ebfu kh\u00e1ng l\u1ef1c ph\u1ed5i t\u0103ng nhi\u1ec1u, ch\u1ee7 y\u1ebfu l\u1edbn th\u1ea5t ph\u1ea3i.<\/p>\n

3.2\u00a0 X-quang<\/h3>\n

+ XQ b\u00ecnh th\u01b0\u1eddng n\u1ebfu shunt nh\u1ecf.<\/p>\n

+ Tim to v\u1edbi l\u1edbn nh\u0129 tr\u00e1i, th\u1ea5t tr\u00e1i. T\u0103ng tu\u1ea7n ho\u00e0n ph\u1ed5i.<\/p>\n

+ Kh\u00e1ng l\u1ef1c ph\u1ed5i t\u0103ng nhi\u1ec1u, b\u00f3ng tim nh\u1ecf l\u1ea1i v\u1edbi h\u00ecnh \u1ea3nh c\u1eaft c\u1ee5t \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i.<\/p>\n

3.3\u00a0 Si\u00eau \u00e2m tim<\/h3>\n

+ Si\u00eau \u00e2m 2D \u0111\u00e1nh gi\u00e1 k\u00edch th\u01b0\u1edbc, v\u1ecb tr\u00ed, h\u00ecnh d\u1ea1ng theo Krichenko, \u0111\u01b0\u1eddng k\u00ednh v\u00e0 chi\u1ec1u d\u00e0i PDA<\/p>\n

+ Si\u00eau \u00e2m doppler \u0111\u00e1nh gi\u00e1 lu\u1ed3ng shunt.<\/p>\n

 <\/p>\n

4. Di\u1ec5n ti\u1ebfn t\u1ed3n t\u1ea1i \u1ed1ng \u0111\u1ed9ng m\u1ea1ch<\/h2>\n

+ PDA th\u01b0\u1eddng kh\u00f4ng t\u1ef1 \u0111\u00f3ng \u1edf tr\u1ebb s\u01a1 sinh \u0111\u1ee7 th\u00e1ng nh\u01b0 tr\u1ebb non th\u00e1ng do b\u1ea5t th\u01b0\u1eddng v\u1ec1 c\u01a1 tr\u01a1n h\u01a1n l\u00e0 s\u1ef1 gi\u1ea3m \u0111\u00e1p \u1ee9ng v\u1edbi oxy.<\/p>\n

+ Suy tim v\u00e0 vi\u00eam ph\u1ed5i t\u00e1i ph\u00e1t n\u1ebfu shunt l\u1edbn.<\/p>\n

+ B\u1ec7nh l\u00fd m\u1ea1ch m\u00e1u ph\u1ed5i ph\u00e1t tri\u1ec3n n\u1ebfu shunt l\u1edbn kh\u00f4ng \u0111i\u1ec1u tr\u1ecb.<\/p>\n

+ Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c, th\u01b0\u1eddng x\u1ea3y ra PDA nh\u1ecf h\u01a1n l\u00e0 PDA l\u1edbn.<\/p>\n

+ S\u1ef1 h\u00ecnh th\u00e0nh t\u00fai ph\u00ecnh v\u00e0 c\u00f3 th\u1ec3 v\u1ee1 (hi\u1ebfm).<\/p>\n

5. \u0110i\u1ec1u tr\u1ecb t\u1ed3n t\u1ea1i \u1ed1ng \u0111\u1ed9ng m\u1ea1ch<\/h2>\n

5.1 \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/h3>\n

+ H\u1ea1n ch\u1ebf d\u1ecbch, gi\u1eef Hct 35-40%, cung c\u1ea5p \u0111\u1ee7 oxy v\u00e0 PEEP cao.<\/p>\n

+ \u0110\u00f3ng PDA b\u1eb1ng thu\u1ed1c: Indomethacin hay ibuprofen (tr\u1ebb thi\u1ebfu th\u00e1ng).<\/p>\n

+ \u0110i\u1ec1u tr\u1ecb suy tim<\/p>\n

+ Ph\u00f2ng vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c.<\/p>\n

5.2\u00a0 \u0110\u00f3ng PDA b\u1eb1ng th\u00f4ng tim can thi\u1ec7p<\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/p>\n

+ Tr\u1ebb s\u01a1 sinh c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng nh\u01b0ng \u0111\u00f3ng b\u1eb1ng thu\u1ed1c th\u1ea5t b\u1ea1i<\/p>\n

+ Tr\u1ebb l\u1edbn: c\u00f3 tri\u1ec7u ch\u1ee9ng tr\u00ean l\u00e2m s\u00e0ng.<\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n

+ Kh\u00e1ng l\u1ef1c m\u1ea1ch m\u00e1u ph\u1ed5i > 8 \u0111\u01a1n v\u1ecb Woods.<\/p>\n

+ PVR\/SVR >0.5.<\/p>\n

+ \u1ed0ng \u0111\u1ed9ng m\u1ea1ch lu\u1ed3ng th\u00f4ng ph\u1ea3i \u2013 tr\u00e1i.<\/p>\n

+ C\u00f3 t\u1eadt TBS l\u1ec7 thu\u1ed9c \u1ed1ng \u0111\u1ed9ng m\u1ea1ch.<\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p: PDA < 4mm, d\u00f9ng coil.\u00a0 4mm-10mm d\u00f9ng Amplatzer PDA device.<\/p>\n

\"dong-tong-tai-ong-dong-mach\"
\u0110\u00f3ng PDA b\u1eb1ng th\u00f4ng tim can thi\u1ec7p<\/figcaption><\/figure>\n

\u01afu \u0111i\u1ec3m: nhanh ch\u00f3ng, ti\u1ec7n l\u1ee3i c\u00f3 th\u1ec3 ch\u1ec9 g\u00e2y t\u00ea t\u1ea1i ch\u1ed7, th\u1eddi gian n\u1eb1m vi\u1ec7n ng\u1eafn, kh\u00f4ng \u0111\u1ec3 l\u1ea1i s\u1eb9o.<\/p>\n

Khuy\u1ebft \u0111i\u1ec3m: shunt t\u1ed3n l\u01b0u, thuy\u00ean t\u1eafc coil, t\u00e1n huy\u1ebft, h\u1eb9p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i tr\u00e1i, h\u1eb9p l\u00f2ng \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 t\u1eafc m\u1ea1ch \u0111\u00f9i.<\/p>\n

5.3\u00a0 Ph\u1eabu thu\u1eadt<\/h3>\n

Ch\u1ec9 \u0111\u1ecbnh:<\/strong> PDA b\u1ea5t k\u1ec3 k\u00edch th\u01b0\u1edbc.<\/p>\n

Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh<\/strong> khi c\u00f3 b\u1ec7nh m\u1ea1ch m\u00e1u ph\u1ed5i t\u1eafc ngh\u1ebdn.<\/p>\n

Th\u1eddi \u0111i\u1ec3m: 6 th\u00e1ng-2 tu\u1ed5i hay b\u1ea5t c\u1ee9 th\u1eddi \u0111i\u1ec3m n\u00e0o khi ph\u00e1t hi\u1ec7n (\u0111\u1ed1i v\u1edbi tr\u1ebb l\u1edbn).<\/p>\n

Ph\u01b0\u01a1ng ph\u00e1p:<\/strong> c\u1ed9t hay c\u1eaft PDA qua m\u1edf th\u00e0nh ng\u1ef1c v\u00f9ng sau b\u00ean tr\u00e1i kh\u00f4ng c\u1ea7n tim ph\u1ed5i nh\u00e2n t\u1ea1o. C\u00f3 th\u1ec3 ph\u1eabu thu\u1eadt PDA qua n\u1ed9i soi th\u00e0nh ng\u1ef1c.<\/p>\n

Bi\u1ebfn ch\u1ee9ng:<\/strong> hi\u1ebfm. T\u1ed5n th\u01b0\u01a1ng th\u1ea7n kinh thanh qu\u1ea3n qu\u1eb7t ng\u01b0\u1ee3c (kh\u00e0n gi\u1ecdng), li\u1ec7t th\u1ea7n kinh ho\u00e0nh tr\u00e1i, t\u1ed5n th\u01b0\u01a1ng \u1ed1ng ng\u1ef1c tr\u00e1i (tr\u00e0n d\u1ecbch d\u01b0\u1ee1ng ch\u1ea5p). T\u00e1i th\u00f4ng l\u00e0 bi\u1ebfn ch\u1ee9ng hi\u1ebfm n\u1ebfu ch\u1ec9 c\u1ed9t m\u00e0 kh\u00f4ng c\u1eaft.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

\u1ed0ng \u0111\u1ed9ng m\u1ea1ch n\u1ed1i \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i (t\u1eeb v\u1ecb tr\u00ed ph\u00e2n nh\u00e1nh) v\u1edbi em \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 (5-10mm c\u00e1ch n\u01a1i xu\u1ea5t ph\u00e1t \u0111\u1ed9ng m\u1ea1ch d\u01b0\u1edbi \u0111\u00f2n tr\u00e1i). 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